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Background
Amidst shortages of critical care capacity in the public sector during the COVID-19 pandemic, the South African government embarked on an initiative to purchase critical bed capacity from the private sector. To inform the decision, we assessed the cost-effectiveness of ICU management for admitted COVID-19 patients across the public and private health systems in South Africa.
Methods
Using a Markov modelling framework and health system perspective, costs and health outcomes of inpatient management of severe and critical COVID-19 patients in (1) general ward and intensive care (GW+ICU) and (2) general ward only were assessed. Disability adjusted life years (DALYs) were evaluated and the cost per admission in public and private sectors was determined. The models made use of four variables: mortality rates, utilisation of inpatient days for each management approach, disability weights associated to the severity of the disease, and the unit cost per general ward day and per ICU day in public and private hospitals. Unit costs were multiplied by utilisation estimates to determine the cost per admission. DALYs were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). An incremental cost-effectiveness ratio (ICER) - representing the difference in costs and health outcomes of the two management strategies - was compared to a cost-effectiveness threshold to determine the value for money of ICU management.
Results
A cost per admission of ZAR 75,127 was estimated for inpatient management of severe and critical COVID-19 patients in general wards only as opposed to ZAR 103,030 in GW+ICU. DALYs were 1.48 and 1.10 in the general ward only and GW+ICU, respectively. The ratio of difference in costs and health outcomes between the two management strategies produced an ICER equal to ZAR 73,091 per DALY averted, a value above the cost-effectiveness threshold of ZAR 38,465.
Conclusions
Results indicated that purchasing ICU capacity from the private sector may not be a cost-effective investment. The ‘real time’, rapid, pragmatic, and transparent nature of this analysis demonstrates an approach for evidence generation for decision making relating to the COVID-19 pandemic response and South Africa’s wider priority setting agenda.
Keywords
COVID-19, SARS-CoV-2, cost-effectiveness, intensive care unit, priority setting, South Africa
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CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 1
Posted 04 Dec, 2020
No community comments so far
Editorial decision: Minor revision
On 18 Dec, 2020
Review #2 received
Received 17 Dec, 2020
Review #1 received
Received 17 Dec, 2020
Reviewer #2 agreed
On 22 Nov, 2020
Editor assigned
On 22 Nov, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Reviewer #1 agreed
On 22 Nov, 2020
Submission checks complete
On 22 Nov, 2020
Editor invited
On 19 Nov, 2020
First submitted
On 16 Nov, 2020
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See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 1
Posted 04 Dec, 2020
No community comments so far
Editorial decision: Minor revision
On 18 Dec, 2020
Review #2 received
Received 17 Dec, 2020
Review #1 received
Received 17 Dec, 2020
Reviewer #2 agreed
On 22 Nov, 2020
Editor assigned
On 22 Nov, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Reviewer #1 agreed
On 22 Nov, 2020
Submission checks complete
On 22 Nov, 2020
Editor invited
On 19 Nov, 2020
First submitted
On 16 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background
Amidst shortages of critical care capacity in the public sector during the COVID-19 pandemic, the South African government embarked on an initiative to purchase critical bed capacity from the private sector. To inform the decision, we assessed the cost-effectiveness of ICU management for admitted COVID-19 patients across the public and private health systems in South Africa.
Methods
Using a Markov modelling framework and health system perspective, costs and health outcomes of inpatient management of severe and critical COVID-19 patients in (1) general ward and intensive care (GW+ICU) and (2) general ward only were assessed. Disability adjusted life years (DALYs) were evaluated and the cost per admission in public and private sectors was determined. The models made use of four variables: mortality rates, utilisation of inpatient days for each management approach, disability weights associated to the severity of the disease, and the unit cost per general ward day and per ICU day in public and private hospitals. Unit costs were multiplied by utilisation estimates to determine the cost per admission. DALYs were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). An incremental cost-effectiveness ratio (ICER) - representing the difference in costs and health outcomes of the two management strategies - was compared to a cost-effectiveness threshold to determine the value for money of ICU management.
Results
A cost per admission of ZAR 75,127 was estimated for inpatient management of severe and critical COVID-19 patients in general wards only as opposed to ZAR 103,030 in GW+ICU. DALYs were 1.48 and 1.10 in the general ward only and GW+ICU, respectively. The ratio of difference in costs and health outcomes between the two management strategies produced an ICER equal to ZAR 73,091 per DALY averted, a value above the cost-effectiveness threshold of ZAR 38,465.
Conclusions
Results indicated that purchasing ICU capacity from the private sector may not be a cost-effective investment. The ‘real time’, rapid, pragmatic, and transparent nature of this analysis demonstrates an approach for evidence generation for decision making relating to the COVID-19 pandemic response and South Africa’s wider priority setting agenda.
Figure 1
Figure 2
Figure 3
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